Targeted CPAP Therapy for Obstructive Sleep Apnea in Pregnancy

Objective/Hypothesis: The purpose of this study is to determine if parturients identified as high risk for obstructive sleep apnea (OSA; defined as an apnea hypopnea index [AHI] ≥5 events/hour) who are randomized to receive an unattended sleep study during early and late pregnancy (early = between 6 and 16 weeks; late = between 27 and 33 weeks) plus initiation of CPAP therapy if the AHI ≥5 events/hour and standard prenatal care have a decreased incidence of adverse pregnancy outcomes (defined as a composite variable which includes gestational hypertension, preeclampsia, eclampsia, gestational diabetes, preterm birth, low birth weight, or stillbirth) at the time of delivery when compared to a group who receives standard prenatal care only (no sleep study and CPAP initiation). At 8 to 12 months postpartum subjects in both groups will complete a sleep study.

Inclusion criteria

• At least one of the following risk factors for OSA: prepregnancy BMI ≥ 30kg/m2, chronic hypertension, pregestational diabetes, twin gestation, or a history of prior pregnancy affected by: preeclampsia, eclampsia or fetal growth restriction.
• Between 6 and 16 weeks gestation at time of enrollment.

Exclusion criteria

• Current diagnosis and treatment of OSA.
• Patient refusal to randomization.
• Permanent Pacemaker (interfere with WATCHPAT sleep study).
• Currently taking alpha blockers or nitrates (interfere with WATCHPAT sleep study).
• Coronary artery disease or congestive heart failure or cardiomyopathy.
• Not delivering and completing their postpartum visit at Naval Medical Center San Diego (NMCSD).
• Inability to read or understand the consent.
• <18 years of age.